ASHES, Vol. 7(3) - Smoke, or e-Smoke?

Previously, we have discussed the safety and efficacy of e-cigarettes (i.e., a battery-powered device with a refillable nicotine cartridge and a heater that vaporizes a nicotine solution; ASHES, Vol. 6(4)). Current research indicates that e-cigarette liquid and vapor contain significantly fewer chemicals than tobacco cigarettes. In fact, research suggests that harmful chemicals, if any, occur in trace amounts; these characteristics are similar to other nicotine replacement tools (Cahn & Siegel, 2011). This week’s ASHES reviews a study of the effectiveness of e-cigarettes for smoking cessation (Siegel, Tanwar, & Wood, 2011).

Methods

• Siegel et al. (2011) sent an online survey to the first 5,000 people who bought a new e-cigarette seven months after their initial purchase.
  • Of the sample, 222 participants responded (4.5% response rate), but six were excluded from the survey because they did not meet the inclusion criteria for having been a smoker (i.e., lifetime cigarettes smoked ≥ 100).
• Participants (n = 216) completed an online survey that 1) described their typical pattern of e-cigarette and cigarette use at six months post-purchasing e-cigarettes, and 2) compared their overall smoking behavior during the six months following their initial e-cigarettes purchase to their smoking behavior prior to purchasing e-cigarettes.

Results

• Participants reported the following changes in smoking behavior during the six months following purchasing e-cigarettes: 143 reported smoking fewer cigarettes daily, 106 reported reduced nicotine use, and 104 reported they quit smoking for a period of time.
• Table 1 shows participants’ reported smoking patterns at six months follow-up.
  • Thirty percent of the sample (67 of 216, 30%) reported that they were not smoking cigarettes.
  • Among the 149 smokers, nearly equal numbers were using (52%) or not using (48%) e-cigarettes.
  • Among the 67 non-smokers, there were proportionately more participants using e-cigarettes (61%) than not (39%).
• The relationship between using e-cigarettes and smoking was not statistically significant (² (1 df) = 1.46, p = .23). 

Table 1 - Smoking status by use of e-cigarettes

 

Limitations

• This study uses retrospective self-report without chemical verification.
• The results might not be generalizable to all people who use e-cigarettes because (a) the researchers only surveyed one e-cigarette brand and (b) the response rate was extremely low suggesting that the participants might not represent e-cigarette users.

Discussion

These results suggest that there might be an association between smoking reductions and using e-cigarettes (i.e., as the number of daily e-cigarette usage increased, the percentage of participants not smoking at six months increased). However, the results are not statistically significant when investigators compared participants who smoked and used e-cigarettes to those who smoked and did not use e-cigarettes. The same distribution in a sample containing about 100 more cases would be statistically significant, however, suggesting that the e-cigarette effect is small. Nonetheless, small effects can have considerable impact if this approach to stopping smoking was widely accepted.

Current research is mixed about whether e-cigarettes reduce craving (Bullen et al., 2009; Eissenberg, 2010), but some evidence suggests that simply holding a cigarette can help fight craving (Barrett, 2010). Using e-cigarettes mimics traditional cigarette use, so this could be the reason for the observed association between not smoking and/or reducing smoking tobacco cigarettes. Nevertheless, more research is needed to determine the efficacy of e-cigarettes as a smoking cessation tool, including more comprehensive safety tests.

-Tasha Chandler

What do you think? Please use the comment link below to provide feedback on this article.

References

Barrett, S. P. (2010). The effects of nicotine, denicotinized tobacco, and nicotine-containing tobacco on cigarette craving, withdrawal, and self-administration in male and female smokers. Behavioural Pharmacology, 21(2), 144-152. doi: doi:10.1097/FBP.0b013e328337be68

Bullen, C., McRobbie, H., Thomley, S., Glover, M., Lin, R., & Laugesen, M. (2010). Effect of an electronic nicotine delivery device (e cigarette) on desire to smoke and withdrawal, user preferences and nicotine delivery: Randomised cross-over trial. Tobacco Control, 19, 98-103. doi: 10.1136/tc.2009.031567

Cahn, Z., & Siegel, M. B. (2011). Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? Journal of Public Health Policy, 32, 16-31. doi: 10.1057/jphp.2010.41

Eissenberg, T. (2010). Electronic nicotine delivery devices: Ineffective nicotine delivery and craving suppression after acute administration. Tobacco Control, 19, 87-88. doi: 10.1136/tc.2009.033498

Siegel, M. B., Tanwar, K. L., & Wood, K. S. (2011). Electronic cigarettes as a smoking-cessation tool results from an online study. American Journal of Preventive Medicine, 40(4), 472-475. doi: 10.1016/j.amepre.2010.12.006

Comments

[scrappy-girl]

I purchaed the e-cig approximately 2 months ago. I used it initially with the intention of alternating between real cigarettes and the e-cig in an effort to cut down. The e-cig was a bit awkward and tasted differently. I ended up putting it to the side for a few weeks. Eventually I picked it back up again. It took a little time to get used to the difference between a real cig and the e-cig but since last week I quit smoking and between the use of a nicotine patch, nicotine gum and the e-cig I have remained cigarette free. At this point (1 wk later) I am now only using the ecig with nicotine gum every once in a while but mostly just the ecig. I feel that the ehalation of "smoke" is the enjoyable part and I have been refraining from smoking a real cigarette whose smoke is much harsher. I can only hope that the nicotine in the atomizer is not coming out onto my tongue rom puffing and in effect cause problems for me later as I think I can taste it sometimes. This atomizer does not require refill.
I was previously a smoker of 16 years who had quit for 5 years and had restarted smoking for the last 8 months.